A biliary tract obstruction complicated by acute appendicitis and portal vein thrombosis-a case report and review of literature

Abstract

Introduction and importance Acute appendicitis is one of the most common surgical diagnoses in clinical practice. In case of uncomplicated course, diagnosis and treatment do not cause significant difficulties. On the other hand, unrecognized or complicated appendicitis can rarely bring unusual complications that threaten the patient with delayed treatment rather than the course itself. Portal vein thrombosis, also known as pylephlebitis, with an incidence of 1/1000 acute admissions, certainly meets this statement. Case presentation In this study, we present a successful treatment of advanced acute appendicitis complicating treatment of biliary obstruction. Due to the advanced inflammation with forced intestinal resection in the extent of right-sided hemicolectomy. And then successful conservative treatment of portal vein thrombosis in the surgical facility lasting a total of 6 weeks when the patient was discharged to home care without sequelae. Clinical discussion The epidemiology, presentation, diagnosis and strategy of treatments as well as their outcomes were discussed. Conclusion Portal vein thrombosis after acute appendicitis is rare. In case of unfavorable postoperative course with high inflammatory markers, temperatures, discomfort and abdominal pain, a CT scan is in order, which can easily establish the diagnosis and subsequently target the treatment in the right direction. Treatment of pylephlebitis is conservative and long term. It consists in the application of low molecular weight heparin and targeted antibiotic treatment. The mortality rate is 32%.

Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature

“…Articles published in languages other than English; cases where clinical, microbiological, or radiological studies did not support the diagnosis; case reports not providing an adequate amount of information, as well as those reporting non-human subjects were excluded from the analyses. The final number of articles included was 101, which resulted in total number of 103 patients [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ,…”

Pylephlebitis combined with septic shock secondary to acute nonperforated appendicitis: a case report

“…7 Unfortunately, although pylephlebitis usually presents as an acute illness, the primary infection is classified as subacute, and approximately one fifth of all cases are associated with appendicitis, resulting in the death of 11% to 32% of patients. 8 Pylephlebitis cannot be diagnosed immediately in most patients because of nonspecific symptoms. 9 Moreover, there is currently no diagnostic criteria for pylephlebitis.…”

Manejo de la pileflebitis como complicación post apendicectomía

“…La duración de la terapia con antibióticos debe continuarse al menos de cuatro a seis semanas después de la presentación de los síntomas, continuando la administración intravenosa hasta que haya una respuesta clínica significativa. El resto de la terapia se puede administrar por vía oral con una combinación de metronidazol y fluoroquinolonas (Ozawa & Shikino, 2021;Řezáč et al, 2021). Además de la terapia con antibióticos, ningún ensayo controlado aleatorio prospectivo establece la utilidad de los anticoagulantes en la pileflebitis, y la mayoría de la evidencia disponible proviene de pequeños estudios observacionales.…”